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a. � 0r, <br /> �( "- )r 'T'OR'N OF MASHPLE <br /> �•.. '-""� /=y,. Statement of Discontinuance, Change of Residence, Change of Location ol'Business, <br /> gtS'%iiiLE'cu� Irawal, or Deceased from Business or Partnership, Change of Business Name or Owner Name <br /> �i1ln �2 � 7 <br /> DATE <br /> The Town is desirous of going <br /> /"��Grr/eeln," as much as possible.To that end, please include your email address. <br /> Email Address: lrt� ��0� kt6- L—'G ✓ <br /> _ Discontinuance <br /> In conformity with the provisions of Chapter one hundred and ten, section five, of the General <br /> Laws, as amended, the undersigned herebL ecla e s) that Mq T (have) this day discontinued (retired <br /> from) (withdrawn from) the business of Irl N/tl <br /> conducted at Q�52 k4TO" ' CUP; IfLAPA . Diel �. M�SµP� . buoZ I <br /> STREET C <br /> V <br /> SIGNATUR. <br /> Change of Location of Business <br /> I hereby state that the location of the business/my residence as it appears on the Business Certificate filed <br /> On has been changed to <br /> Name of Business <br /> SIGNATURE <br /> Change of Name of Business or Owner <br /> I hereby state that the name of the business or the owner as it appears on the Business Certificate has <br /> been changed from D lc1 e N <br /> to <br /> SIGNAlwac <br /> Notary y D <br /> Barnstable ss. <br /> Date <br /> Personally appeared before me the above named �I�y�D w and made oath <br /> that the foregoing statements are true. <br /> is. on Ex *res Ua <br /> IyCarOonFapYe _ <br /> OrigforndDiscontinuance ��IS <br />